Request medical records

Choose your use case below:

1. To request medical records for yourself, use the forms below:
   1. Request to Access Health Information - ENGLISH
   2. Request to Access Health Information - SPANISH
2. To authorize family or support members to access your medical records, use the forms below:
   1. Authorization to Release Protected Health Information to Identified Family/Support Members - ENGLISH
   2. Authorization to Release Protected Health Information to Identified Family/Support Members - SPANISH
   3. Authorization to Release Protected Health Information to Identified Family/Support Members - VIETNAMESE
3. To send medical records to another health facility or provider, use the forms below:
   1. Release of Information - ENGLISH
   2. Release of Information - SPANISH
   3. Release of Information - VIETNAMESE
4. To revoke a release of information form, use the form below:
   1. Revocation of Authorization for Use and Disclosure of Protected Health Information - ENGLISH
   2. Revocation of Authorization for Use and Disclosure of Protected Health Information - SPANISH
5. To request to amend your health record, use the form below:
   1. Request to Amend Health Record - ENGLISH
   2. Request to Amend Health Record - SPANISH

Submit signed forms

1. Email to: Medical Records
2. Drop off in-person or mail to:
   • Medical Records Department
     Behavioral Health and Recovery Services
     County of Marin Department of Health and Human Services
     250 Bon Air Road, Unit B
     Greenbrae, CA 94904
3. Fax to: 415-473-4113

Please note that forms require an ink signature.